Provider Demographics
NPI:1831856772
Name:FARRELL, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:FARRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49A NATURE AVE
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-2750
Mailing Address - Country:US
Mailing Address - Phone:860-575-9636
Mailing Address - Fax:
Practice Address - Street 1:365 MONTAUK AVE
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4769
Practice Address - Country:US
Practice Address - Phone:860-442-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-28
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT143016163WC0200X
CT15262364SC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SC0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistCritical Care MedicineGroup - Multi-Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine